The following has been created in response to member questions pertaining to medication administration.
Q.: “I am a nurse working in a nursing home. Can I pre-pour medications into a ‘day’ container or medication box for the resident who may be going out on pass?”
A.: Yes, a day minder is acceptable for use by a self-directed resident leaving the nursing home setting. This practice is also permissible in the home care setting, only if the patient is self-directed.
An RN is responsible for determining the extent to which a patient is self-directed, and the decision should be made by the RN preparing the medications. Suitable patients are those who are able to demonstrate a consistent ability to self-medicate once the container is adequately prepared.Up to eight days of medications may be pre-poured to support this patient's independence with the rationale that the patient should be re-evaluated at least weekly. Preparing medications in advance includes the pre-filling of insulin syringes.
Q.: “As a nurse in an OMRDD certified setting, I have been asked to pre-pour medications into a medication box for unlicensed assistive personnel (UAP) to administer. Is this acceptable?”
A.: Because the law permits unlicensed assistive personnel (UAP) in OMRDD certified facilities to administer medications, pre-pouring of medications is not necessary. However, administration of medications by unlicensed assistive personnel is only appropriate if the individual(s) who will be administering the medications successfully completed a required training, which designates them as qualified to administer medications in OMRDD certified facilities only.
In group or adult home settings, consideration should be given to the best method to assure appropriate storage to avoid inadvertent or intentional use by other patients.
Q.: “I received an order to change the dosage of one of the medications for a home care patient. The patient recently had this prescription refilled and cannot afford to discard the existing medication. Since the tablets are scored, is it acceptable for me to make a change on the label of the existing bottle to reflect to new orders?”
A.: Under normal circumstances labeling a medication bottle falls within the scope of practice of pharmacy, not nursing. However, in discussions with the NYS Pharmacy Board, agreement has been reached that in this instance, noting a change on the existing bottle is probably the safest method for communicating the change to other caregivers and family members rather than leaving a message, which might be accidentally discarded. Also, be sure to document the change in the patient's progress record. Under normal circumstances labeling a medication bottle falls within the scope of practice of pharmacy, not nursing.
Q.: “As a school health nurse, I'm faced with how to handle a student requiring medication while on a field trip.”
A.: The nurse may take one dose from the original labeled container, place it in an envelope with the student's name, medication, dosage and instructions for taking.
Q.: “Many students report allergies and, as such, epi-pens are now available in the school. What will happen if I am unavailable to administer?”
A.: Unlicensed persons may administer epi-pens in an emergency. However, since an unlicensed person may not have the expertise of a licensed professional nurse to assess the student's condition and exercise professional judgment about the reaction or response to the medication, the unlicensed person should only be used when a registered nurse is not immediately available.
Q.: “I work the night shift in an Emergency Department. Occasionally, it is necessary to provide a patient with medication upon discharge, until they can get a prescription filled at the Pharmacy. Is this an acceptable practice?”
A. : Insuring a patient has medications available in a timely fashion is good practice. However, Nurses (other than Nurse Practitioners) are not authorized to dispense in New York State. By definition, dispensing is a multiphase process. It includes compounding, packaging, or labeling a substance and delivering the substance to the patient.
While nurses may not dispense, they may assist a prescriber in providing a twenty-four hour supply of medications by pouring the medication and labeling. Proper labeling includes the patient's name, medication name, dosage and instructions per the prescriber, the prescriber's name, facility, phone number, date, and amount of medication in the container. It is the responsibility of the prescriber to verify the accuracy of the medication and labeling and to hand it directly to the patient.
The same procedure for labeling and delivering to the patient applies when dispensing samples in clinics and medical offices.
Q.: “I'm a nurse who works part-time in a planned-parenthood clinic. Many of our clients return to pick up oral contraceptive packs when a prescriber is not on site. Can I provide or is this considered dispensing?”
A.: Dispensing medications is limited in New York State to authorized prescribers. A nurse is unable to perform this task unless recognized as an authorized prescriber.
For questions related to this alert, contact Education, Practice and Research: 518.782.9400, ext. 282